RESUMEN
INTRODUCTION: Hyponatremia is a well-documented adverse effect of oxcarbazepine treatment, but no clinical trial has yet been conducted to explore any intervention for reducing the incidence of hyponatremia. MATERIALS AND METHODS: This open-label trial evaluated the efficacy of add-on daily oral sodium chloride supplementation of 1-2 g/day for 12 weeks in reducing the incidence of hyponatremia in children receiving oxcarbazepine monotherapy aged 1-18 years. Apart from comparing the incidence of symptomatic and severe hyponatremia, serum and urine sodium levels, serum and urine osmolality, changes in behavior and cognition, and the number of participants with recurrence of seizures and requiring additional antiseizure medication (ASM) were also compared. RESULTS: A total of 120 children (60 in each group) were enrolled. The serum sodium level at 12 weeks in the intervention group was higher than that of the control group (136.5 ± 2.6 vs 135.4 ± 2.5 mEq/L, p = 0.01). The number of patients with hyponatremia was significantly lower in the intervention group (4/60vs14/60, p = 0.01). However, the incidence of symptomatic and severe hyponatremia (0/60vs1/60, p = 0.67 for both), changes in social quotient and child behavior checklist total score (0.6 ± 0.8 vs 0.7 ± 0.5, p = 0.41 and 0.9 ± 1.2 vs 1.1 ± 0.9, p = 0.30 respectively), the number of patients with breakthrough seizures (9/60vs10/60, p = 0.89), and the number of patients requiring additional ASMs (8/60vs10/60, p = 0.79) were comparable in both groups. CONCLUSIONS: Daily oral sodium chloride supplementation is safe and efficacious in reducing the incidence of hyponatremia in children with epilepsy receiving oxcarbazepine monotherapy. However, sodium chloride supplementation does not significantly reduce more clinically meaningful outcome measures like symptomatic and severe hyponatremia. Trial registry No. CTRI/2021/12/038388.
Asunto(s)
Anticonvulsivantes , Epilepsia , Hiponatremia , Oxcarbazepina , Cloruro de Sodio , Humanos , Hiponatremia/prevención & control , Hiponatremia/inducido químicamente , Hiponatremia/epidemiología , Femenino , Masculino , Niño , Preescolar , Anticonvulsivantes/uso terapéutico , Anticonvulsivantes/efectos adversos , Lactante , Adolescente , Oxcarbazepina/uso terapéutico , Oxcarbazepina/efectos adversos , Epilepsia/tratamiento farmacológico , Administración Oral , Incidencia , Cloruro de Sodio/uso terapéutico , Cloruro de Sodio/administración & dosificación , Cloruro de Sodio/efectos adversos , Resultado del Tratamiento , Sodio/sangre , Sodio/orinaRESUMEN
Hyponatraemia has indeed been extensively studied from multiple angles, including volume status, tonicity, and aetiology; however, the specific consideration of the osmolar gap (OG) within the context of hyponatraemia and its potential impact on their overall outcomes received limited attention in research. The current study represents an effort to address this gap in our understanding. This prospective exploratory study was conducted on adults aged 14 years and older at the Indus Hospital, Karachi, from 2017 to 2020. The study involved categorising severity of hyponatraemia and volume status. The osmolar gap (OG) was calculated and categorised as either increased (OG>10) or normal (OG<10). Among the 262 patients included in the study, there were 139 females and 123 males. Elevated OG was observed in 141(53.8%) patients. There were 28 (10.7%) recorded fatalities and majority of these individuals had an elevated OG. These findings underscore the importance for clinicians to consider the osmolar gap when managing patients with hyponatraemia.
Asunto(s)
Hiponatremia , Humanos , Hiponatremia/epidemiología , Hiponatremia/fisiopatología , Femenino , Masculino , Adulto , Persona de Mediana Edad , Estudios Prospectivos , Concentración Osmolar , Anciano , Adulto Joven , Pakistán/epidemiología , AdolescenteRESUMEN
BACKGROUND: The incidence of dysnatremia in children with acute gastritis/gastroenteritis varies, and factors associated with either dysnatremia or hyponatremia at presentation have not been identified clearly. METHODS: This retrospective study included patients aged 1 month to 18 years hospitalized for community-acquired acute gastritis/gastroenteritis from January to October 2016. Factors associated with dysnatremia at presentation were identified using multivariable analysis. RESULTS: Among the 304 children included, the median age was 2.2 (1.0, 4.2) years. The incidence of dysnatremia at presentation was 17.1% (hyponatremia 15.8%; hypernatremia 1.3%). Patients who had moderate (p = 0.03) and severe dehydration (p = 0.04) and presented with vomiting and diarrhea simultaneously (p = 0.03) were associated with dysnatremia at presentation. Patients presented with vomiting and diarrhea simultaneously was associated with hyponatremia at presentation (p = 0.02). CONCLUSIONS: Dysnatremia was common in children with acute gastritis/gastroenteritis. Moderate to severe dehydration and the presence of vomiting and diarrhea simultanously were significantly associated with dysnatremia at presentation. Furthermore, presenting with vomiting and diarrhea silmutaneously was associated with hyponatremia at presentation. Serum electrolytes should be monitored in patients with those conditions.
Asunto(s)
Deshidratación , Gastritis , Gastroenteritis , Hipernatremia , Hiponatremia , Humanos , Gastritis/epidemiología , Gastritis/complicaciones , Gastritis/diagnóstico , Masculino , Femenino , Estudios Retrospectivos , Preescolar , Incidencia , Lactante , Hiponatremia/epidemiología , Hiponatremia/etiología , Niño , Adolescente , Enfermedad Aguda , Gastroenteritis/complicaciones , Gastroenteritis/epidemiología , Deshidratación/epidemiología , Deshidratación/etiología , Deshidratación/complicaciones , Hipernatremia/epidemiología , Hipernatremia/etiología , Hipernatremia/diagnóstico , Hipernatremia/complicaciones , Factores de Riesgo , Diarrea/epidemiología , Diarrea/etiología , Vómitos/epidemiología , Vómitos/etiologíaRESUMEN
Exertional hyponatremia, or exercise-associated hyponatremia, occurs within 24 hours after physical activity due to a serum, plasma, or blood sodium concentration (Na+) below the normal reference range of 135 mEq/L. If not detected early and managed properly, hyponatremia can be fatal. From 2008 to 2023, 1,812 cases of exertional hyponatremia were diagnosed among U.S. active component service members (ACSMs), with an overall incidence rate of 8.3 cases per 100,000 person-years (p-yrs). In 2023 there were 153 cases of exertional hyponatremia diagnosed among ACSMs, resulting in a crude incidence rate of 11.7 per 100,000 p-yrs. Female service members, those older than 40, non-Hispanic Black service members, Marine Corps members, recruits, those in combat-specific occupations, and ACSMs stationed in the Northeast U.S. region had higher incidence rates of exertional hyponatremia diagnoses than their respective counterparts. During the surveillance period, annual rates of incident exertional hyponatremia diagnoses peaked in 2010 (12.8 per 100,000 p-yrs) and then decreased to a low of 5.3 cases per 100,000 p-yrs in 2013. Thereafter the incidence rate fluctuated but has increased from 6.2 per 100,000 p-yrs in 2017 to its second-highest level in 2023. Service members and their supervisors should be aware of the dangers of excessive fluid consumption and prescribed limits for consumption during prolonged physical activity including field training exercises, personal fitness training, or recreational activities, particularly in hot, humid weather.
Asunto(s)
Hiponatremia , Personal Militar , Esfuerzo Físico , Vigilancia de la Población , Humanos , Hiponatremia/epidemiología , Hiponatremia/etiología , Femenino , Personal Militar/estadística & datos numéricos , Estados Unidos/epidemiología , Adulto , Incidencia , Masculino , Esfuerzo Físico/fisiología , Adulto Joven , Persona de Mediana EdadRESUMEN
BACKGROUND: Patients are commonly monitored for hyponatremia after intracranial procedures, yet the prevalence of hyponatremia after cranial vault reconstruction (CVR) remains unclear. The purpose of this study is to define the prevalence, risk factors, and complications of hyponatremia after CVR to optimize postoperative sodium surveillance protocols. METHODS: Patients with nonsyndromic, single-suture craniosynostosis who underwent primary CVR between 2009 and 2020 at Michigan Medicine were included (n = 231). Demographic, intraoperative, and postoperative characteristics were compared by postoperative hyponatremia status at P < 0.05 significance. Hyponatremia was defined as mild (<135 mEq/L), moderate (<130 mEq/L), or severe (<125 mEq/L) based on the lowest postoperative laboratory draw. RESULTS: Twenty-three patients (10.0%) developed mild postoperative hyponatremia. No patient developed moderate or severe postoperative hyponatremia. On multivariable regression, decreased preoperative sodium level (P = 0.03) and decreased preoperative weight (P = 0.02) were significantly associated with mild postoperative hyponatremia. No patient developed complications or required hospital readmission because of hyponatremia. CONCLUSIONS: This large retrospective cohort study of patients with nonsyndromic single-suture craniosynostosis demonstrated a 10% prevalence of mild, clinically inconsequential hyponatremia and 0% prevalence of moderate or severe, clinically significant hyponatremia after primary CVR. Patients with low preoperative sodium level or weight were at increased risk for developing mild postoperative hyponatremia. The results suggest that patients with preoperative sodium greater than 140 mEq/L or preoperative weight greater than 10 kg may be candidates for limited postoperative sodium surveillance; however, future prospective studies are warranted before implementation. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.
Asunto(s)
Craneosinostosis , Hiponatremia , Procedimientos de Cirugía Plástica , Complicaciones Posoperatorias , Humanos , Hiponatremia/epidemiología , Hiponatremia/etiología , Craneosinostosis/cirugía , Femenino , Masculino , Estudios Retrospectivos , Prevalencia , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Procedimientos de Cirugía Plástica/efectos adversos , Procedimientos de Cirugía Plástica/métodos , Lactante , Factores de Riesgo , Michigan/epidemiología , Cráneo/cirugíaRESUMEN
The aim of this study was to analyze the impact and the clinical and evolutionary characteristics of hypotonic hyponatremia in patients hospitalized in Internal Medicine units. Prospective multicenter observational study of patients with hypotonic hyponatremia (<135 mmol/L) in 5 hospitals in southern Spain. Patients were included according to point prevalence studies carried out every 2 weeks between March 2015 and October 2017, by assessing demographic, clinical, analytical, and management data; each patient was subsequently followed up for 12 months, during which time mortality and readmissions were assessed. A total of 501 patients were included (51.9% women, mean ageâ =â 71.3â ±â 14.24 years), resulting in an overall prevalence of hyponatremia of 8.3%. The mean comorbidities rate was 4.50â ±â 2.41, the most frequent diagnoses being heart failure (115) (23%), respiratory infections (65) (13%), and oncological pathologies (42) (6.4%). Of the total number of hyponatremia cases, 180 (35.9%) were hypervolemic, 164 (32.7%) hypovolemic, and 157 (31.3%) were euvolemic. A total of 87.4% did not receive additional diagnostic tests to establish the origin of the condition and 30% did not receive any treatment. Hospital mortality was 15.6% and the mean length of stay was 14.7 days. Euvolemic and admission hyponatremia versus hyponatremia developed during admission were significantly associated with lower mortality rates (Pâ =â .037). Mortality at 1 year and readmissions were high (31% and 53% of patients, respectively). Hyponatremia was common in Internal Medicine areas, with hypervolemic hyponatremia being the most frequent type. The mortality rate was high during admission and at follow-up; yet there is a margin for improvement in the clinical management of this condition.
Asunto(s)
Mortalidad Hospitalaria , Hiponatremia , Medicina Interna , Humanos , Hiponatremia/epidemiología , Hiponatremia/etiología , Hiponatremia/diagnóstico , Femenino , Masculino , Anciano , Estudios Prospectivos , España/epidemiología , Persona de Mediana Edad , Anciano de 80 o más Años , Hospitalización/estadística & datos numéricos , Prevalencia , Readmisión del Paciente/estadística & datos numéricos , Tiempo de Internación/estadística & datos numéricos , Comorbilidad , Unidades HospitalariasRESUMEN
OBJECTIVE: Both hyponatremia and hypernatremia have been reported to occur more frequently with higher ambient temperatures, although the underlying mechanisms are not well understood. Global temperatures are rising due to climate change, which may impact the incidence of dysnatremia worldwide. We aimed to identify, collate and critically appraise studies analyzing the relationship between climate measures (outdoor temperature, humidity) and serum sodium concentrations. DESIGN: Systematic review, reported in accordance with PRISMA guidelines. METHODS: MEDLINE and Embase were searched with relevant key terms. Studies assessing the effect on serum sodium measurement of elevated temperature or humidity versus a comparator were included. RESULTS: Of 1466 potentially relevant studies, 34 met inclusion criteria, originating from 23 countries spanning all inhabited continents. The majority (30 of 34, 88%) reported a significant association between outdoor temperature and dysnatremia, predominantly lower serum sodium with increased ambient temperature. Humidity had a less consistent effect. Individuals aged above 65 years, children, those taking diuretics and antidepressants, those with chronic renal impairment or those undertaking physical exertion had increased vulnerability to heat-associated dysnatremia. The risk of bias was assessed to be high in all but four studies. CONCLUSIONS: Higher ambient temperature is consistently associated with an increased incidence of hyponatremia. We infer that hyponatremia presentations are likely to rise with increasing global temperatures and the frequency of extreme heat events secondary to climate change. Evidence-based public health messages, clinician education and reduction in fossil fuel consumption are necessary to reduce the expected burden on healthcare services worldwide.
Asunto(s)
Cambio Climático , Hipernatremia , Hiponatremia , Sodio , Temperatura , Humanos , Humedad , Hipernatremia/epidemiología , Hipernatremia/sangre , Hiponatremia/epidemiología , Hiponatremia/sangre , Sodio/sangreRESUMEN
OBJECTIVE: Thiazides are the first-line treatment for hypertension, however, they have been associated with hospitalizations for thiazide-associated hyponatremia (TAH). The aim of this study was to evaluate the risk of TAH and other drug-associated hyponatremia in a Korean population. METHODS: The study used big data from the National Health Insurance Sharing Service of 1,943,345 adults treated for hypertension from January 2014 to December 2016. The participants were divided into two groups based on the use of thiazides. Cox proportional hazard models were used to identify independent risk factors for the occurrence of hyponatremia. RESULTS: The study found that hyponatremia-related hospitalizations were significantly higher in the thiazide group than the control group (2.19% vs. 1.45%). The risk increased further with concurrent use of other diuretics or desmopressin, and thiazide+spironolactone+desmopressin and hospitalization risk further increased (4.0 and 6.9 times). Multivariate analysis showed that hyponatremia occurrence increased with age, diabetes mellitus, depression, and thiazide use (hazard ratio = 1.436, p < 0.001). The thiazide group had better 6-year overall survival than the control group but had more fractures and hyponatremia. CONCLUSIONS: Thiazide use is associated with an increased risk of hyponatremia and related complications. However, the mortality rate decreased in those who received thiazides, suggesting that thiazide use itself is not harmful and may help decrease complications and improve prognosis with proper, cautious use in high-risk patients.
Asunto(s)
Hipertensión , Hiponatremia , Tiazidas , Humanos , Hiponatremia/inducido químicamente , Hiponatremia/epidemiología , Femenino , Masculino , Persona de Mediana Edad , Hipertensión/tratamiento farmacológico , Anciano , Tiazidas/efectos adversos , República de Corea/epidemiología , Estudios de Cohortes , Factores de Riesgo , Inhibidores de los Simportadores del Cloruro de Sodio/efectos adversos , Hospitalización/estadística & datos numéricos , Adulto , Modelos de Riesgos Proporcionales , Antihipertensivos/efectos adversos , Antihipertensivos/uso terapéuticoRESUMEN
Bacterial meningitis is a life-threatening disease. Bacterial meningitis patients are prone to develop acute hyponatremia. In the central nervous system infection hyponatremia could be due to the Syndrome of Inappropriate Anti Diuretic Hormone secretion. The frequency of hyponatremia in adults with acute bacterial meningitis patients was seen in this study. This cross-sectional study was conducted in the Internal Medicine Department of Mymensingh Medical College Hospital, Mymensingh, Bangladesh from February 2016 to July 2016. A total of 50 patients were enrolled in this study by purposive sampling. Among 50 acute bacterial meningitis patients, 33 (66%) were diagnosed as hyponatremic state. The mean serum sodium level of 33 hyponatremic bacterial meningitis cases was 130.66±2.95 mmol/L. Most of the cases (78.79%) were mild hyponatremic state (130 mmol/L-135 mmol/L) whereas 18.18% were revealed as moderate hyponatremia (125 mmol/L-129 mmol/L). Only 3.03% of cases were presented as severe cases (≤124 mmol/L). The result revealed that a large number of patients with acute bacterial meningitis were suffering from hyponatremia and in the majority of cases were mildly hyponatremic.
Asunto(s)
Hiponatremia , Meningitis Bacterianas , Adulto , Humanos , Hiponatremia/epidemiología , Hiponatremia/etiología , Estudios Transversales , Meningitis Bacterianas/complicaciones , Meningitis Bacterianas/epidemiología , Bangladesh/epidemiologíaRESUMEN
BACKGROUND: This research aims to examine the frequency, age-related distribution, and intensity of preoperative hyponatremia among elderly individuals with hip fractures. This study aims to provide valuable insights into the diagnosis of preoperative hyponatremia in this patient population. METHODS: This research involved the analysis of clinical data obtained from 419 elderly individuals with hip fractures (referred to as the fracture group) and 166 elderly individuals undergoing routine health examinations (designated as the control group). A comprehensive comparison was conducted, examining baseline characteristics such as age, gender, and comorbidities between these two groups. We further investigated variations in the incidence rate of hyponatremia, age distribution, and the severity of hyponatremia. Additionally, a subgroup analysis compared patients with femoral neck fractures to those with intertrochanteric femur fractures, specifically examining the incidence rate and severity of hyponatremia in these distinct fracture types. RESULTS: The incidence of cerebrovascular disease was found to be higher in the fracture group as compared to the control group in our research. Nevertheless, no significant differences in general health and other comorbidities were observed between the two groups. Notably, the fracture group exhibited a greater preoperative prevalence of hyponatremia, with its severity increasing with age. Furthermore, among elderly patients with intertrochanteric femur fractures, the incidence of preoperative hyponatremia was not only higher but also more severe when compared to those with femoral neck fractures. CONCLUSION: Elderly individuals experiencing hip fractures exhibit a notable prevalence of preoperative hyponatremia, predominantly mild to moderate, with an escalating occurrence linked to advancing age. This phenomenon is especially conspicuous among patients with intertrochanteric fractures, warranting dedicated clinical scrutiny. The administration of sodium supplementation is advisable for the geriatric demographic as deemed necessary. Addressing hyponatremia becomes crucial, as it may play a role in the etiology of hip fractures in the elderly, and rectifying this electrolyte imbalance could potentially serve as a preventive measure against such fractures.
Asunto(s)
Fracturas del Cuello Femoral , Fracturas de Cadera , Hiponatremia , Humanos , Anciano , Estudios Retrospectivos , Hiponatremia/epidemiología , Hiponatremia/etiología , Fracturas de Cadera/complicaciones , Fracturas de Cadera/epidemiología , Fracturas de Cadera/cirugía , Fracturas del Cuello Femoral/complicaciones , Fracturas del Cuello Femoral/epidemiología , Fracturas del Cuello Femoral/cirugía , SodioRESUMEN
BACKGROUND: Craniopharyngiomas are low-grade malignancies (WHO I) in the sellar region. Most cases of childhood-onset craniopharyngioma are adamantinomatous craniopharyngioma, and neurosurgery is the treatment of choice. Affected patients have postoperative complications, including water and electrolyte disturbances, because these malignancies develop near the hypothalamus and pituitary gland. Determining postoperative serum sodium fluctuation patterns in these patients can reduce postoperative mortality and improve prognosis. OBJECTIVE: To measure changes in serum sodium levels in pediatric patients who underwent craniopharyngioma surgery and identify influencing factors. METHODS: This retrospective study measured the serum sodium levels of 202 patients aged 0-18 years who underwent craniopharyngioma resection in Beijing Tiantan Hospital and Beijing Children's Hospital and identified predictors of severe hyponatremia and hypernatremia. RESULTS: The mean age of the cohort was 8.35 ± 4.35 years. The prevalence of hypernatremia, hyponatremia, and their severe forms (serum Na+ > 150 mmol/L and serum Na+ < 130 mmol/L) within 14 days after surgery was 66.3%, 72.8%, 37.1%, and 40.6%, respectively. The mean postoperative serum sodium level showed a triphasic pattern, characterized by two peaks separated by a nadir. Sodium levels peaked on days 2 (143.6 ± 7.6 mmol/L) and 14 (143.2 ± 6.7 mmol/L) and reached their lowest on day 6 (135.5 ± 7.5 mmol/L). A total of 31 (15.3%) patients met the diagnostic threshold for hyponatremia and hypernatremia of the triphase response, whereas 116 (57.4%) patients presented this pattern, regardless of met the diagnostic criteria or not. The prevalence of severe hyponatremia varied depending on preoperative endocrine hormone deficiency, tumor status (primary or recurrent), and surgical approach. CONCLUSIONS: Serum sodium levels after craniopharyngioma resection in children showed a triphasic pattern in most cases. The risk of postoperative hyponatremia varied depending on preoperative endocrine hormone deficiency, tumor status (primary or recurrent), and surgical approach.
Asunto(s)
Craneofaringioma , Hipernatremia , Hiponatremia , Neoplasias Hipofisarias , Humanos , Niño , Preescolar , Craneofaringioma/cirugía , Hipernatremia/epidemiología , Hipernatremia/etiología , Hiponatremia/epidemiología , Hiponatremia/etiología , Estudios Retrospectivos , Neoplasias Hipofisarias/cirugía , Hormonas , SodioRESUMEN
BACKGROUND: Hyponatremia (hypoNa) is a potentially serious adverse event of antidepressant treatment. Previous research suggests the risk of drug-induced hyponatremia differs between antidepressants. This meta-analysis sought to determine the risk of antidepressant-induced hypoNa, stratified by different compounds and classes. METHODS: A PRISMA-compliant systematic search of Web of Science and PubMed databases was performed from inception until Jan 5, 2023, for original studies reporting incidences or risks of hypoNa in adults using antidepressants. We modelled random-effects meta-analyses to compute overall event rates and odds ratios of any and clinically relevant hypoNa for each compound and class, and ran head-to-head comparisons based on hypoNa event rates. We conducted subgroup analyses for geriatric populations and sodium cut-off value. The study is registered with PROSPERO, CRD42021269801. RESULTS: We included 39 studies (n = 8,175,111). Exposure to antidepressants was associated with significantly increased odds of hypoNa (k = 7 studies, OR = 3.160 (95%CI 1.911-5.225)). The highest event rates were found for SNRIs (7.44%), SSRIs (5.59%), and TCAs (2.66%); the lowest for mirtazapine (1.02%) and trazodone (0.89%). Compared to SSRIs, SNRIs were significantly more likely (k = 10, OR = 1.292 (1.120 - 1.491), p < 0.001) and mirtazapine significantly less likely (k = 9, OR = 0.607 (0.385 - 0.957), p = 0.032) to be associated with hypoNa. CONCLUSION: Our meta-analysis demonstrated that, while no antidepressant can be considered completely risk-free, for hypoNa-prone patients mirtazapine should be considered the treatment of choice and SNRIs should be prescribed more cautiously than SSRIs and TCAs.
Asunto(s)
Antidepresivos , Hiponatremia , Humanos , Hiponatremia/inducido químicamente , Hiponatremia/epidemiología , Antidepresivos/efectos adversos , Inhibidores Selectivos de la Recaptación de Serotonina/efectos adversos , Mirtazapina/efectos adversosRESUMEN
Hyponatremia on admission has been related to worse outcomes in patients with COVID-19 infection. However, little is known about the frequency and the associated risk factors of hyponatremia after COVID-19 discharge. We performed an observational 24-month follow-up study of patients admitted during the first COVID-19 wave. Kaplan-Meier curves and Cox proportional hazard models were used to assess the main variables in predicting hyponatremia on follow-up (HYPO-FU). A total of 161 out of 683 (24.4%) developed HYPO-FU. The group with HYPO-FU comprised of more men [(62.3%) vs. (49.2%); p < 0.01], older [65.6 ± 18.2 vs. 60.3 ± 17.0; p < 0.01] and more frequently re-admitted [(16.2%) vs. (3.8%); p < 0.01). The rate of HYPO-FU was higher in the first year 23.6 per 100 individuals per year. After Cox regression analysis, the independent risk factors of HYPO-FU were diabetes [OR 2.12, IC 95% (1.48-3.04)], hypertension [OR 2.18, IC 95% (1.53-3.12)], heart failure [OR 3.34, IC 95% (1.72-6.48)] and invasive ventilation support requirement [OR: 2.38, IC 95% (1.63-3.50)]. To conclude, HYPO-FU was frequent in the first year after COVID-19 infection, and the risk was higher in older men with comorbidities, increasing rehospitalisation. Further studies aimed at evaluating the beneficial effects of correcting hyponatremia in these patients are warranted.
Asunto(s)
Líquidos Corporales , COVID-19 , Insuficiencia Cardíaca , Hiponatremia , Anciano , Humanos , Masculino , COVID-19/complicaciones , COVID-19/epidemiología , Estudios de Seguimiento , Hiponatremia/epidemiología , Hiponatremia/etiologíaRESUMEN
OBJECTIVE: Hyponatremia is associated with considerable morbidity and mortality, but causal links have been difficult to establish. Here, we describe the establishment and representativeness of the Stockholm Sodium Cohort (SSC), designed to study etiologies and outcomes of hyponatremia. STUDY DESIGN AND SETTING: All residents of Stockholm County undertaking at least one serum sodium test between 2005-2018 were included in the SSC. Individual-level test results from over 100 laboratory parameters relevant to hyponatremia were collected and linked to data on demographics, socioeconomic status, healthcare contacts, diagnoses and dispensed prescription medications using national registers. RESULTS: A total of 1,632,249 individuals, corresponding to 64% of the population of Stockholm County, were included in the SSC. Coverage increased with advancing age, ranging from 32% in children and adolescents (≤18 years) to 97% among the oldest (≥80 years). The coverage of SSC included the vast majority of patients in Stockholm County diagnosed with diabetes mellitus (93%), myocardial infarction (98%), ischemic stroke (97%), cancer (85%), pneumonias requiring inpatient care (95%) and deaths (88%). CONCLUSION: SSC is the first cohort specifically designed to investigate sodium levels in a large, population-based setting. It includes a wide range of administrative health data and laboratory analyses. The coverage is high, particularly among elderly and individuals with comorbidities. Consequently, the cohort has a large potential for exploration of various aspects of hyponatremia.
Asunto(s)
Hiponatremia , Sodio , Niño , Adolescente , Humanos , Anciano , Hiponatremia/epidemiología , Comorbilidad , Morbilidad , HospitalizaciónRESUMEN
Hyponatremia is a typical side effect of antiseizure drugs from the dibenzazepine family. The study investigated the prevalence of hyponatremia in patients with epilepsy who were treated with eslicarbazepine. We aimed to determine the prevalence of hyponatremia, reveal the factors leading to the discontinuation of treatment, and identify possible risk factors for the development of hyponatremia including the dose dependency. The medical records of 164 patients with epilepsy taking eslicarbazepine in our center were analyzed. The overall prevalence of hyponatremia was 30.5%. The prevalence of mild hyponatremia, seen in 14%-20% of patients, was not dose dependent. The prevalence of moderate and severe hyponatremia was significantly dose dependent. The severity of hyponatremia was significantly dose dependent. Severe hyponatremia was found in 6.1% of patients. Hyponatremia was asymptomatic in the majority of cases, and in 48% did not require any management. Hyponatremia was the reason for discontinuation in 6.2% of patients. The major risk factor for developing hyponatremia was older age. The study shows that eslicarbazepine-induced hyponatremia is usually mild and asymptomatic. It usually does not require any management and seldom leads to treatment discontinuation. Hyponatremia is dose dependent. Another major risk for developing hyponatremia (besides dose) is older age.
Asunto(s)
Dibenzazepinas , Epilepsia , Hiponatremia , Humanos , Hiponatremia/inducido químicamente , Hiponatremia/epidemiología , Anticonvulsivantes/efectos adversos , Estudios Retrospectivos , Dibenzazepinas/efectos adversos , Epilepsia/tratamiento farmacológico , Epilepsia/complicacionesRESUMEN
Acute electrolyte and acid-base imbalance is experienced by many children following kidney transplant. This is partly because doctors give very large volumes of artificial fluids to keep the new kidney working. When severe, fluid imbalance can lead to seizures, cerebral edema and death. In this pragmatic, open-label, randomized controlled trial, we randomly assigned (1:1) pediatric kidney transplant recipients to Plasma-Lyte-148 or standard of care perioperative intravenous fluids (predominantly 0.45% sodium chloride and 0.9% sodium chloride solutions). We then compared clinically significant electrolyte and acid-base abnormalities in the first 72 hours post-transplant. The primary outcome, acute hyponatremia, was experienced by 53% of 68 participants in the Plasma-Lyte-148 group and 58% of 69 participants in the standard fluids group (odds ratio 0·77 (0·34 - 1·75)). Five of 16 secondary outcomes differed with Plasma-Lyte-148: hypernatremia was significantly more frequent (odds ratio 3·5 (1·1 - 10·8)), significantly fewer changes to fluid prescriptions were made (rate ratio 0·52 (0·40-0·67)), and significantly fewer participants experienced hyperchloremia (odds ratio 0·17 (0·07 - 0·40)), acidosis (odds ratio 0·09 (0·04 - 0·22)) and hypomagnesemia (odds ratio 0·21 (0·08 - 0·50)). No other secondary outcomes differed between groups. Serious adverse events were reported in 9% of participants randomized to Plasma-Lyte-148 and 7% of participants randomized to standard fluids. Thus, perioperative Plasma-Lyte-148 did not change the proportion of children who experienced acute hyponatremia compared to standard fluids. However fewer fluid prescription changes were made with Plasma-Lyte-148, while hyperchloremia and acidosis were less common.
Asunto(s)
Acidosis , Hiponatremia , Trasplante de Riñón , Desequilibrio Hidroelectrolítico , Humanos , Niño , Cloruro de Sodio/efectos adversos , Hiponatremia/epidemiología , Hiponatremia/etiología , Electrólitos/efectos adversos , Acidosis/etiología , Acidosis/inducido químicamente , Desequilibrio Hidroelectrolítico/etiología , Desequilibrio Hidroelectrolítico/inducido químicamente , Fluidoterapia/efectos adversos , Soluciones Isotónicas/efectos adversos , Gluconatos , Cloruro de Potasio , Cloruro de Magnesio , Acetato de SodioRESUMEN
INTRODUCTION: Hyponatremia is the most common electrolyte disorder often present in peritoneal dialysis (PD) patients. The aim of this retrospective study was to investigate the effect of hyponatremia on mortality in patients undergoing PD. METHODS: The health records of adult individuals with an inserted PD catheter identified via the centralized national e-health database were used. RESULTS: The mean age of the 846 patients included in the study was 52.48 years (±14.6). The mean sodium level was 136.51 mEq/L. Sodium levels <137 mEq/L were associated with higher death risk independent of comorbidities. There was a 0.821 times less reduction in mortality for each mEq /L increase in serum sodium. CONCLUSION: Our study provides evidence that monitoring and adjusting serum sodium levels is crucial in managing PD patients with hyponatremia, as low serum sodium level was found to be a significant and independent predictor of mortality.
Asunto(s)
Hiponatremia , Diálisis Peritoneal , Adulto , Humanos , Persona de Mediana Edad , Hiponatremia/epidemiología , Hiponatremia/etiología , Estudios Retrospectivos , Inflamación/complicaciones , SodioRESUMEN
PURPOSE: Pituitary transposition is a novel surgical approach to access the retroinfundibular space and interpeduncular cistern. Few studies have evaluated post-surgical outcomes, including incidence of hyponatremia, following pituitary transposition. METHODS: This is a retrospective study including 72 patients who underwent endoscopic endonasal surgery involving pituitary transposition for non-pituitary derived tumors over a decade at the University of Pittsburgh Medical Center. Anterior pituitary deficiencies and replacement therapy, tumor pathology and pre-operative serum sodium (Na) were recorded. Na was assessed at postoperative day 1, 3, 5, 7, and 10. Anatomical/surgical parameters included sellar height, sellar access angle to approach the tumor, and cranial extension of the tumor above the sellar floor (B) compared to the height of the gland (A) (B/A). T-test (normally distributed variables) and Wilcoxon rank-sum test (not-normally distributed) were applied for mean comparison. Logistic regression analyzed correlations between anatomical/surgical parameters and postoperative hyponatremia. RESULTS: 55.6% of patients developed post-operative transient hyponatremia. Two patients (5%) developed severe hyponatremia (sodium level < 120 mmol/L). Eleven (15.3%) patients required desmopressin replacement immediately post-operatively, and 2 other patients needed desmopressin after discharge and after sodium nadir developed. Hyponatremia was inversely associated with sellar access angle (p = 0.02) and the tumor cranial extension above the sellar floor showing a trend towards significance (p = 0.09). CONCLUSION: More than half of patients who had pituitary transposition developed transient hyponatremia. Hyponatremia was more common in those with narrower sellar access angle and smaller cranial extension of the tumor above the sellar floor. Anatomical/surgical parameters may allow risk-stratification for post-operative hyponatremia following pituitary transposition.
Asunto(s)
Hiponatremia , Neoplasias , Enfermedades de la Hipófisis , Neoplasias Hipofisarias , Humanos , Hiponatremia/epidemiología , Hiponatremia/etiología , Estudios Retrospectivos , Incidencia , Desamino Arginina Vasopresina/uso terapéutico , Base del Cráneo/patología , Sodio , Neoplasias Hipofisarias/patologíaRESUMEN
BACKGROUND: According to drug labels, the frequency of thiazide-induced hyponatremia is unknown or uncommon to very rare (that is, <1 in 10 000 to <1 in 100), but the exact burden remains unclear. OBJECTIVE: To estimate the increase in the cumulative incidence of hyponatremia using thiazide diuretics compared with nonthiazide antihypertensive drugs in routine clinical practice. DESIGN: Population and register-based cohort study using target trial emulation. SETTING: Denmark, 1 January 2014 to 31 October 2018. PARTICIPANTS: Two target trials were emulated among persons aged 40 years or older who had no recent prescription for any antihypertensive drug, had no previous hyponatremia, and were eligible for the studied antihypertensive treatments. The first target trial emulation compared new use of bendroflumethiazide (BFZ) versus a calcium-channel blocker (CCB). The second target trial emulation compared new use of hydrochlorothiazide plus a renin-angiotensin system inhibitor (HCTZ-RASi; that is, combination pill) versus a RASi alone. MEASUREMENTS: Two-year cumulative incidences of sodium levels less than 130 mmol/L using stabilized inverse probability of treatment-weighted survival curves. RESULTS: The study compared 37 786 new users of BFZ with 44 963 of a CCB and 11 943 new users of HCTZ-RASi with 85 784 of a RASi. The 2-year cumulative incidences of hyponatremia were 3.83% for BFZ and 3.51% for HCTZ-RASi. The risk differences were 1.35% (95% CI, 1.04% to 1.66%) between BFZ and CCB and 1.38% (CI, 1.01% to 1.75%) between HCTZ-RASi and RASi; risk differences were higher with older age and higher comorbidity burden. The respective hazard ratios were 3.56 (CI, 2.76 to 4.60) and 4.25 (CI, 3.23 to 5.59) during the first 30 days since treatment initiation and 1.26 (CI, 1.09 to 1.46) and 1.29 (CI, 1.05 to 1.58) after 1 year. LIMITATION: The study assumed that filled prescriptions equaled drug use, and residual confounding is likely. CONCLUSION: Treatment initiation with thiazide diuretics suggests a more substantial excess risk for hyponatremia, particularly during the first months of treatment, than indicated by drug labeling. PRIMARY FUNDING SOURCE: Independent Research Fund Denmark.